Candidate: The candidate is an Assistant Professor and Director of Biomedical Ethics in Internal Medicine at the Univ. of Texas-Houston. During her fellowship she completed research about informed consent for prostate specific antigen screening that led to a National Research Service Award from the AHCPR/HSRA. She is in the second year of a 3- year K08 Award from the NCI. Through the K08 she has acquired quantitative research skills and written grants funded by the CDC and Dept. of Defense. She serves on the State Prostate Cancer Advisory Committee to the Texas Dept. of Health and on an advisory committee to Project JOLT at the NCI. Research: By building upon skills and research from the K08, this K02 well enable the candidate to become an independent investigator. The proposed pilot project will move her work in informed decision making into a new medium, the Internet and e-mail, and to a new clinical problem, colorectal cancer screening. The rise of the Internet brings new possibilities to the delivery of preventive health care. Personal information from the electronic medical record and educational information about colorectal cancer screening will be delivered to patients through a tailored, interactive Internet letter called the "NetLET," at home, work, or at a public library. The aims are to: 1) develop the NetLET (interNet LETter) and demonstrate that it can be feasibly implemented with physicians and patients in a primary care practice and city public library system; 2) conduct a pilot evaluation of the NetLET's effect on adherence to colorectal cancer screening compared to a standard mailed letter to inform the design of a larger trial; 3) assess the effect of the NetLET on interest in and knowledge about colorectal cancer screening compared to a standard mailed letter to inform the design of a larger trial. This study will recruit 220 patients and randomize them to intervention and control groups, stratified by gender and by 'private' (eg. home, work) or 'public' access to e-mail. 'Public' access for those who otherwise lack computer access will be through the Houston Public Library and the Harris County Public Library systems. Patients in the intervention group will receive the NetLET; patients in the control, a customized personal letter by mail. This pilot study will assess the effect of the NetLET on colorectal cancer screening compliance and will determine barriers to 'public' access to the intervention. This proposal will lead to RO1 studies that will examine how electronic interventions can promote informed decision-making and deliver preventive health care. Environment:The Texas Medical Center, UT-School of Public Health and M.D. Anderson Cancer Center offer nationally known resources to meet the interdisciplinary needs of the candidate.